Lee T Ackley, RPA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

003464-1 Issued in NY

Practice address

39 Farrell Road
Willsboro, NY 12996

Phone

(518) 963-4275

Fax

(518) 963-8862

NPI assigned

Feb 1, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Beach Medical Services

  • Primary Care Clinic/Center
  • Plattsburgh, NY
  • NPI 1881078079
  NPD (past)
• Jonathan Beach DO PLLC

  • Urgent Care Clinic/Center
  • Plattsburgh, NY
  • NPI 1104023910
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1902944044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 331",
            "city": "ESSEX",
            "state": "NY",
            "postal_code": "129360331",
            "telephone_number": "518-963-4275",
            "fax_number": "518-963-8862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 FARRELL ROAD",
            "city": "WILLSBORO",
            "state": "NY",
            "postal_code": "12996",
            "telephone_number": "518-963-4275",
            "fax_number": "518-963-8862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ACKLEY",
        "first_name": "LEE",
        "middle_name": "T",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "003464-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT LICEN",
            "identifier": "003464-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adirondack Apothecary LLC
• Adirondack Apothecary LLC
• Associated Community Action of the North East Adirondack Region, Inc.
• David George Bonfante, D.D.S.
• Donna Ann Brown-Joerg

• Physician Assistant in Willsboro, NY
• Providers in Willsboro, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.